or her partner together may enable the doctor to ask about the influence of the disease on their partnership and thus allow them to discuss emotionally loaded topics together. Local support groups can also be invaluable. Many patients and their partners find that the leaflets, meetings, and other facilities of the Multiple Sclerosis Society and Action for Research into Multiple Sclerosis provide support that neither health nor social service professionals can give. Offering to help patients with multiple sclerosis and their families in these ways is a vital aspect of management and will remain so until traditional therapeutic endeavours become effective. A 0 FRANK

Northwick Park Hospital, Harrow, Middlesex HA1 3UJ 1 Webb HE. Multiple sclerosis: therapeutic pessimism. BMJ 1992;304:1260-1. (16 May.) 2 Langton-Hewer R. Multiple sclerosis: management and rehabilitation. International Rehabilitation Medicine 1980;2: 116-25. 3 Burnfield AJ, Frank AO. Multiple sclerosis. In: Frank AO, Maguire GP, eds. Disabling diseases: physical, environmental and psycho-social management. Oxford: Heinemann Medical, 1989:168-90. 4 Coster GM, Sturge JC, Williams KA, Frank AO. Pilot investigation into the needs of children when one parent has multiple sclerosis [Abstract]. Clinical Rehabilitation 1989;3:80.

Study of factors in atherogenesis EDITOR, -We are the authors of a paper, published last year, on the interactions of serum copper, selenium, and low density lipoprotein cholesterol concentrations in carotid atherogenesis.' In the methods section we gave details of the assessment of atherosclerosis and stated (fourth and fifth sentences of this subsection): "The intima media thickness was measured from video recordings of the entire scanning procedures by the scanning physician (RS). The reader was blinded with regard to the subjects' identify and whether she was reading a baseline or a two year follow up recording." This part of the description of the method was inaccurate. Technically speaking, the entire scanning procedures were not video recorded: roughly half of the whole scanning time was recorded. The recordings included, however, the imaging of the entire length of the common carotid arteries. Secondly, when the intima media thickness was measured the identities of subjects were not literally hidden from the observer as this was not possible. The baseline and follow up videotapes were, however, read in a random order. The reader was blinded to all risk factor values and, when she was reading the follow up tapes, to the baseline measurements of intima media thickness. We used the term blinded as the observer made about 8400 measurements over 13 months and could not possibly have remembered the previous readings for any single person. Also, the computerised videotape reading equipment gave the distance reading only after both the lumen-intima interface and the media-adventitia interface had been defined by cursors driven by software. We do not believe that these minor inaccuracies in any way undermine the validity of either our findings or our

conclusions. To verify this, the same observer repeated the baseline and two year follow up measurements of intima media thickness from the original video recordings, which had been stored for three to five years, in a random order and blinded, as far as possible, with regard to the identities of the subjects. The mean of the absolute differences between the original and repeat measurements was 0 07 mm (0-08 mm for the increase in two years). The intraclass correlation coefficient for agreement between all original and all repeat measurements



27 JUNE 1992

Mean increase in maximal carotid intima media thickness after two years (mm) (adjusted for age and cigarette pack years) according to serum copper and low density lipoprotein cholesterol concentration, from original and repeat measurements

formed in vitro fertilisation treatment? Why should a consent by the parents bar such an action? More debate is needed on this. J G DUDDINGTON Worcester WR2 4PB

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Patterns of hospital medical staffing.

or her partner together may enable the doctor to ask about the influence of the disease on their partnership and thus allow them to discuss emotionall...
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